基于博弈论的医院处方外流的研究
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篇名: 基于博弈论的医院处方外流的研究
TITLE:
摘要: 目的:分析政府、公立医院、零售药店三个主要利益主体间导致处方外流困难的原因及利益诉求点,扫清处方外流障碍。方法:以博弈论为视角,分析政府与公立医院之间的博弈、公立医院与零售药店之间的博弈,并提出相应的政策建议。结果:在政府与公立医院间的博弈中,从政府的预期收益看,当公立医院消极履行公开处方责任时所获的经济收益增加,政府预期收益增加,反之减小。当医院积极对待处方外流而受到奖励增加时,政府预期收益减小,但政府监管成本上升后,监管程度会减弱;从医院的预期收益看,当政府监管处方外流的管理成本增加,医院的预期收益减小。当医院消极履行处方外流责任受到惩罚增加,医院的预期收益增加。政府损失的社会效益与医院预期收益成正比。在医院与零售药店间的博弈中,从医院的预期收益看,当医院积极推行处方外流而零售药店消极对待时的医院收益增加,医院的预期收益增加;从零售药店的预期收益看,当零售药店消极对待处方外流时,零售药店收益减小,反之增加。当零售药店因积极对待处方外流而转型消耗的成本增加时,零售药店收益增加。结论:政府部门对于公立医院应制定统一的监管标准,对于医院不愿意配合处方外流的行为采取相应的惩罚措施,对于零售药店也应加强监管;卫生部门需要及时给予医院“合理”的财政补偿,积极配合医院解决运营压力的需求,鼓励医院与诊所将处方交给患者到零售药店取药;零售药店也应该加快转型,提升专业服务能力。
ABSTRACT: OBJECTIVE: To analyze the causes of the difficulties in prescription outflow among the three main interests as the government, public hospitals and retail pharmacies, as well as the interest claims, and clear the barriers to prescription outflow. METHODS: From the perspective of game theory, the game between government and public hospitals and the game between public hospitals and retail pharmacies were analyzed, and corresponding policy recommendations were proposed. RESULTS: In game between government and public hospital, from aspect of government’s expected revenue, when public hospitals failed to perform the duty of opening prescription, the profits gained and expected revenue were increased, vice versa. The expected revenue of the government decreased when the rewards for hospital’s active treatment of prescription outflow were increased; when the cost of government regulation increased, regulation degree would weaken. From aspect of hospital’s expected revenue, when the regulatory cost of government regulation outflow was increased, the expected revenue of the hospital decreased. When the punishments for hospital’s failure to perform their duty of prescription outflow, the expected revenue of hospitals increased. The social benefits of government losses were directly positive proportional to the expected revenue of hospitals. In game between hospital and retail pharmacy, form aspect of expected revenue of hospitals, when hospitals actively implemented prescription outflow and retail pharmacies negatively treated it, the expected revenue increased. From aspect of expected revenue of retail pharmacies, when retail pharmacies negatively treated prescription outflow, retail pharmacies gained less and vice versa. Retail pharmacy revenue increased when retail pharmacies positively treated prescription outflow and the cost of restructuring increased. CONCLUSIONS: The government formulate uniform regulation standard for public hospital, take corresponding punishment measures for hospitals unwilling to cooperate with the outflow of prescriptions, and strengthen supervision for retail pharmacies. Health departments need to provide “reasonable” financial compensation in time, actively cooperate with hospitals to solve operational pressure needs, and encourage hospitals and clinics to hand over prescriptions to patients for taking medicine. Retail pharmacies should accelerate the transformation, improve professional service capabilities.
期刊: 2018年第29卷第21期
作者: 朱艳娇,汤少梁
AUTHORS: ZHU Yanjiao,TANG Shaoliang
关键字: 政府;公立医院;零售药店;博弈论;处方外流;政策建议
KEYWORDS: Government; Public hospital; Retail pharmacy; Game theory; Prescription outflow; Policy suggestion
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